Form Yg(4732q) F1 - Recycling Processor Claim

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RECYCLING PROCESSOR CLAIM
Community Services
Summary of Containers Collected and Application for Refund/Handling/Processing Fees
For the period from:______________
To:__________
Processor Name:________________________________________________
Phone Number:_________________
(mm/dd/yy)
(mm/dd/yy)
Aluminum
Small
Large
Refillable
Plastic and Glass
Tetra Paks
Tins
HANDLING FEE AND REFUNDS
Cans
Liquor
Liquor
Beer
Small ( <= 1,000ml ) Large ( > 1,000ml )
Small ( <= 1,000ml ) Large ( > 1,000ml ) Small ( <= 1,000ml ) Large ( > 1,000ml )
Containers Collected by Processor
A
Shipments from non-YLC Depots (EA/BCR10)
B
Total Containers for handling fee (A+B)
0
0
0
0
0
0
0
0
0
0
C
Handling Fee Rate
$0.025
$0.040
$0.075
$0.00
$0.040
$0.075
$0.040
$0.075
$0.040
$0.075
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
D
Handling Fee = (C X Rate)
(0201)
(0205)
(0204)
(0206)
(0203)
(0202)
(0207)
(0208)
(0209)
(0210)
Refund Rate
$0.05
$0.10
$0.25
$0.00
$0.05
$0.25
$0.05
$0.25
$0.05
$0.25
Refunds Paid = (C X Rate)
E
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
(0221)
(0225)
(0224)
(0226)
(0223)
(0222)
(0227)
(0228)
(0229)
(0230)
PROCESSING FEE
Yukon Liquor Corporation (YLC) Containers
F
Total Containers for Processing (C+F)
G
0
0
0
0
0
0
0
0
0
0
Processing Fee Rate
$0.0225
$0.020
$0.040
$0.010
$0.020
$0.040
$0.020
$0.040
$0.020
$0.040
Processing Fee = (G X Rate)
H
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
(0241)
(0245)
(0244)
(0246)
(0243)
(0242)
(0247)
(0248)
(0249)
(0250)
TOTAL AMOUNT CLAIMED
(D+E+H)
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Total This Claim
Completed by:________________________________
Date:_____________________
(please print)
(mm/dd/yy)
Signature:_____________________________________
YG(4732Q)F1 Rev. 02/2012
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